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Being fired twice from two workplaces in a 21-year career wasn’t enough to raise red flags with Ontario’s nursing regulator about Elizabeth Wettlaufer, the ex-nurse who killed eight seniors in two Southwestern Ontario nursing homes and tried to kill four others.

Significantly, one of those firings came days after the last death in Wettlaufer’s seven murders at a Woodstock nursing home, from which she went on to land another job at a London nursing home where her final victim lived.

At that point, her killing spree — injecting vulnerable residents with fatal insulin doses — wasn’t known. Tuesday, as the College of Nurses of Ontario moved to permanently ban Wettlaufer from practising in the province, new details emerged about just how much the college knew — and what interactions it had — with the woman now imprisoned for life as the worst serial killer in Canadian health care.

The college, which regulates the profession, has the power to revoke, suspend or attach conditions to a nurse’s licence to practice. Wettlaufer surrendered her licence in September 2016, after revealing what she’d done to a psychiatrist in Toronto.

The college knew Wettlaufer had been fired in March 2014 from the Caressant Care nursing home in Woodstock, over allegations of repeated medication-related errors, but took no action.

The most significant alleged error was giving insulin meant for one resident to another.

After killing seven residents with insulin overdoses between 2007 and 2014 at Caressant Care, Wettlaufer found a new job at Meadow Park nursing home in London within a month of her termination, according to her statement to police. It was there she administered a deadly insulin does to her eighth and final victim.

The disciplinary panel heard the college looked into Wettlaufer’s firing after it was reported.

College staff spoke to the long-term care home’s nursing director, who said the mistakes didn’t cause any “sustained harm” to residents and weren’t related to any underlying issue or concern with Wettlaufer.

The college, which receives about 1,300 termination notices a year, chose not to launch an investigation.

“There was no allegation whatsoever at that time of any deliberate attempt to overdose a patient. There was no allegation of any deliberateness whatsoever in any of the errors that were identified by the director of nursing,” said Mark Sandler, the college’s lawyer.

No discipline, either, nearly two decades earlier when Wettlaufer was fired from an unnamed hospital for taking drugs from her workplace.

In late 1995, the same year she graduated from Conestoga College’s nursing program, Wettlaufer was fired for pocketing lorazepam, an anxiety drug sold under the brand name Ativan, said college lawyer Megan Shortreed in her submission to the disciplinary committee.

Wettlaufer was found “dazed and disoriented” at work and was hospitalized. Her employer lodged a complaint with the college.

Instead of a discipline hearing, the regulator launched a health inquiry, pushing for rehabilitation rather than punishment. Substance abuse issues notwithstanding, a college committee and two experts deemed Wettlaufer fit to practice, provided she remained alcohol- and drug-free and abided by a set of strict conditions for one year — a move the college still defends.

“We understand that with the benefit of hindsight and what we now know about her activities, everything is coloured by that,” said Sandler, “but the bottom line is that we’re very comfortable with the way in which the college responded in its two interactions with Ms. Wettlaufer.”

Not good enough, said Doris Grinspun, chief executive of the Registered Nurses’ Association of Ontario. She hopes a much-anticipated public inquiry into the murders — announced by the province last month — will shed some light on the long-term care system she said is failing so many.

“It’s time to bring long-term care into the 21st century,” she said.

“We are asking for a broad public inquiry, not only on the matters that had to do with Ms. Wettlaufer but also the day-to-day matters that are happening in nursing homes.”

Grinspun is calling for mandatory reporting and disclosure between employers, especially when nurses are fired. She said she also hopes the inquiry will delve into staffing and supervision issues.

“It’s not just an issue of adding more and more beds in long-term care, it’s what we are doing with the people in those beds,” she said.

Wettlaufer pleaded guilty to eight counts of first-degree murder, four of attempted murder and two of aggravated assault — all, involving vulnerable Southwestern Ontarians in her care — early in June.

She was later sentenced to life in prison, with no chance of parole for 25 years.

Meanwhile, the first two of an expected avalanche of lawsuits in the Wettlaufer case have been filed in London by civil lawyer William Brennan.

On behalf of Arpad Horvath Jr., son of Arpad Horvath Sr., 75, Wettlaufer’s final murder victim, who lived at Meadow Park in London and died Aug. 31, 2014, Brennan has filed a $250,000 statement of claim against Wettlaufer, Caressant Care in Woodstock and Meadow Park and its owners Jarlette Health Services.

Horvath is suing Wettlaufer for administering the fatal dosage of insulin, and alleging negligence against Meadow Park for putting Wettlaufer in a position of authority and Caressant Care for allowing Wettlaufer to “operate undetected due to negligent oversight and management” and “by fraudulently concealing her crimes.”

Caressant Care also failed to monitor the residents and store medications properly, the same suit contends. If the nursing home had detected her murderous behaviour, Horvath’s father wouldn’t have been murdered, the claim alleges.

Brennan also represents Andrea Silcox, one of James Silcox’s daughters, who was 84 when he died after he was overdosed with insulin by Wettlaufer at Woodstock’s Caressant Care on Aug. 17, 2007.

Andrea Silcox is also suing for $250,000, naming Wettlaufer and Caressant Care as defendants.